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Bill lays a brick

On occasion in disability hearings the medical documentation beats around the bush and never really gets down to what is going on. Sometimes this may be due to general practitioners who spend fifteen minutes with any patient, and sometimes it is because the specialist who evaluates and reports is not the right specialist. Bill’s medical documentation reported him as a physically healthy 45-year-old male who was a bricklayer. There was little indication in the medical information why Bill wasn’t out laying bricks, rather than visiting physicians in south Georgia. The obvious inference is because Bill’s problem is located between the ears.

The usual preparation for hearings included spending a day in Atlanta studying the records and taking copious notes in advance of any testimony. For those of you who are not familiar with the history of bricklaying, this particular job has an objective basis on which to evaluate bricklayers. This is simply the number of bricks laid in a day, an hour, or on a job. Of great relevance is whether the bricklayers are union workers, hourly workers, or work on a contract. The incentives make all the difference in the world, except in Bill’s case. Bill was different among bricklayers.

The hearing was begun in the usual fashion in South Georgia, a right to work state, which means that union rules about laying, or not laying bricks did not apply. To be a bricklayer in Georgia requires a contractor, sub-contractor, or home builder to hire individuals to construct a facade of bricks around otherwise frame or concrete structures. Exactly how the employer worked is not particularly relevant, as Bill’s most recent employer was present at the hearing, and asked to be included on the list of folks to testify.

The judge opened with his usual line of questions which included how the individual spends his usual day, where he goes and what he does. Bill focused immediately upon two specific difficulties in his daily routine. The first was his inability to get out of bed in the morning. While it is widely known that certain individuals simply do not like getting up, Bill’s detailed description of the process in his case was possibly classic. He had little trouble getting to a sitting position, but actually rising from sitting to standing was his focus.

As he continued he highlighted the importance of certain details which needed to be arranged “just right” at the time of rising. He mentioned the sheets and covers on the bed, and other objects nearby which needed to be in an acceptable arrangement. As soon as he was able to create this arrangement, he could stand up from the side of the bed. On further questioning he offered that it often required 10 – 20 minutes for him to get out of bed each morning. Presumably this is from that point in time when he decides it is necessary or important to get out of bed.

The second item he offered was leaving the house. The context for leaving was simply to go to the front porch and sit. The difficulty expressed here, a second portal to normal functioning, was getting through the screen door. By this we presumed that he meant opening the door and walking through, rather then by osmosis. He repeated the same 10-20 minutes needed to get through the front door onto the porch.

A third issue arrived through subsequent questioning, and dealt with hand-washing, a common dilemma for folks with obsessive-compulsive disorders. He added this difficulty to his array of performance problems.

From the perspective of work, bricklaying requires a keen eye, arranging all the bricks and mortar in place along a physical line which guides each course of bricks as the wall is constructed. One might infer that this keen eye would enhance the worth of every bricklayer.

When the former employer was sworn in, he was asked about his relationship and kinship with Bill. There was none. He offered his observation of Bill’s performance as a bricklayer one day. While remaining essentially out of sight while Bill was on the scaffold, he indicated that Bill was not just slow laying bricks, he rarely laid any bricks at all during several minutes on the job. This observation was unrelated to availability of bricks, or mortar, or the line which guides each level of bricks. His obvious conclusion was that Bill was unable to perform as a bricklayer until such time as his difficulty was treated effectively.

There was little difficulty agreeing with the testimony of the former employer. While Bill may have had all the requisite skills and experience of a master bricklayer, when the clock is running bricks have to be laid end to end in large numbers every day on the job. Whether getting out of bed, through the door, and on the job, the same pattern applies. Bill may have had a good eye for excellence in the real world, but the notions between his ears kept any of it from happening.

When things have to be just right, this may be a marker of quality control, or in Bills case, a disaster.